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`�� (� �lNSTRU�TI(�N <br />ever�tt �ERMIT PERMITNO. � 7�Q•O <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING Q MECHANICAL C; PLUMBING ❑ SIGN <br />OWNER MAiLR�ORE55 CITY ZIP PNONE <br />Steve Haugen 3911 Hoyt Everett WA 98201 342-Q718 <br />AHCHIiECTOH�ESIGNE� MA�LNDDRE55 CITY ZIP VHONE <br />GFNERAL CONTRRCTOR MAIL PODRE55 CITY 21P PHCNE LICENSE � <br />Valley Natural Gas 1131.3 Highway 99 Everett WA 98203 355-7730 l'ALLENG153LI <br />MFGMRNI^.ALCONTqACTOR MnILqODRESS CITY LIP PIIONE LICENSE• <br />W UM01NG <br />GLRSS OF WORK <br />❑ NEW ❑ ADDITION <br />VFLWTION OF WORK <br />S <br />MAII AppRES] <br />❑ ALTERATION ❑ REPAIR <br />CITY <br />❑ DE.FAOLITION <br />Install 100M conversion burner 1- 50 ga1 water heater <br />�en* sounce <br />❑ ELECI'RICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />� <br />LOT _ BIOCN � OI <br />POORE55 <br />3411 Hoyt <br />PLUMBING <br />TYPE OF FIXTUPE OR ITEM <br />WATER CLOSET ITOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN� <br />SHOWEP <br />KITCHEN SINN 8 DISP <br />DISHWASHER <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />URINFL <br />DRINKING FOUNTAI4 <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINa — RAINLEADEP.S <br />SINK �SEPVICE — DAR, ETC'� <br />TYPE OF CONST <br />SiZE Of BLOG <br />SUU TOTAL <br />PENMIT <br />TOTALFEE <br />GROUP <br />APPLICATION�CCOY � PL4NSCH[CNEO�Y <br />�S <br />9C[SETpACrc <br />VACRNTSrtE <br />❑YES ❑NO <br />NO OF pWELLING UNITS <br />rnaa occ ioAo � <br />APPN pOR 155 W NCE DY <br />vr�OmE �ICf.NSE � <br />❑ BUILDING HELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OP LAWS AND ORC::J4NCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITF; <br />WHETHER SPECIFIED HEREIPJ OF NOT. THE GRANTIhG OF ti <br />PCR�SiT DOES NOT PRESUME TO GIVE AUTHOfIII'i TC <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHFR <br />STATE OR LOCAL LAW REGULATING CONSTRUC'fION OR <br />THE PERFORMANCE OF CONSTFIUCTION. <br />SIGNnTIIqE O� CONTR�CTOR. A�TlYpR12ED AGENT. OR OvrnC' OAt[ <br />V. � l , �I � / i -� <br />MECHANICAL <br />TYPE OF EDUIPMENT <br />A�C — NHNOLG 11N1T5 -- H P <br />REFRIGEPAiION UNITS — H P. EA. <br />BOILERS — � T U rli P <br />GASFlREDAC UNITS—BTL <br />FOHCEO AIR SYSTEMS — B T.U. M EA <br />WALL HEATERS — B TL. M <br />UNIT HEATERS — �.T U. :d <br />EVAPORATIVE COOLERS <br />CLOTHESDRVERS <br />VENTILATION FNN <br />RANGEHO00 �nin�_��ia� <br />WATEN HEti�Eii � <br />WOODSTOVE yMf17'Z'� <br />h1ETAL F IfiEPLAC c 6 CHIMNEK..� � <br />A6i.A_'_' <br />FIRFPLACEINSERT� �PT���.�.��q <br />HEAT PUMP u,.,R,ru <br />GAS PIPING �E�i <br />EXHAUSTFAN <br />SU6TOTAL <br />PEflM1T <br />TOTALFEE <br />NUMBEfl <br />NO <br />YEE ' _-. _. I <br />FEES VALUATION FEE <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />INVESi1GP.TION FEE Sec.304(c) <br />STATE BUILDING SURCHAFlGE <br />STATEENERGVSURCHAFGE <br />DRIVEWAV PERMIT <br />TOTAL <br />PERMIT VALIOATION <br />WfiEN PROPERLV VALIDATED IW THIS SPACEI THI513 VOUR PERMIT <br />31 I 00 <br />O <br />d- <br />N <br />N <br />� <br />